A nurse is caring for a client who is obese. The client is crying and states, "Everyone is staring at me because of my weight." Which of the following responses should the nurse make?

"How long have you struggled with your weight?"

"Let's discuss some weight loss strategies that might work for you."

"It sounds like you're saying that you feel uncomfortable around others."

"Have you always felt uncomfortable being overweight?"

Answer and Explanation

The Correct Answer is C

A. "How long have you struggled with your weight?" While this may provide background information, it shifts the focus to the client's weight history rather than validating their current emotional experience and distress.
B. "Let's discuss some weight loss strategies that might work for you." This response prematurely shifts to problem-solving and weight management without first addressing the client’s emotional needs or acknowledging their feelings of embarrassment and vulnerability.
C. "It sounds like you're saying that you feel uncomfortable around others." This is a therapeutic, reflective response that validates the client’s feelings and encourages them to express more about their emotional experience, fostering trust and emotional support.
D. "Have you always felt uncomfortable being overweight?" This question may come across as judgmental and focuses too much on the client's body image history rather than their current emotional experience, potentially worsening feelings of shame.

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Correct Answer is ["B","C","E"]

Explanation

A. The client engages in quiet activities in their room. While this may seem positive, it is not a reliable indicator of improvement in this context. It could suggest withdrawal or sedation rather than clinical stabilization. Further assessment would be needed to determine its significance.
B. The client slept 5 hr the previous night. This is a clear sign of improvement. The client had not slept for 2 days previously, and sleep is one of the first indicators of recovery in clients experiencing mania. Restorative sleep helps stabilize mood and reduce disorganized thinking.
C. The client takes 2 short naps during the day. Napping indicates the client is able to rest voluntarily, which contrasts with their earlier constant movement and hyperactivity. This suggests reduced mania-related agitation and increased capacity for rest.
D. The client appears to listen to unseen others. This behavior reflects ongoing hallucinations, which indicate that the client is still experiencing active psychosis. This is not an improvement and suggests further monitoring and treatment adjustment may be needed.
E. The client consumes 8 oz of high-calorie fluids each hour. Adequate nutrition and hydration are key components of recovery, especially since the client had been unable to recall their last meal and showed signs of dehydration. This is a positive sign of improved self-care and physical stability.

A. Perform the Credés maneuver B. Maintain the irrigation solution rate. C. Warm the irrigation solution. D. Replace the indwelling urinary catheter

Correct Answer is B

Explanation

A. Perform the Credé’s maneuver. This technique, involving manual pressure on the bladder, is used to promote urination in clients with bladder retention. It is not appropriate for a client with a catheter and continuous bladder irrigation in place.
B. Maintain the irrigation solution rate. Pink-tinged urine is an expected finding 4 hours after a TURP as minor bleeding can occur. There is no need to adjust the irrigation rate unless clots form or the urine becomes bright red or obstructed.
C. Warm the irrigation solution. Warming the solution is not a standard intervention and does not directly manage postoperative bleeding or pink urine. Room temperature solution is typically used unless otherwise specified by the provider.
D. Replace the indwelling urinary catheter. There is no indication the catheter is malfunctioning or obstructed. Pink urine alone does not warrant replacement, and unnecessary catheter changes can increase infection risk.

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A nurse is caring for a client who is obese. The client is crying and states, "Everyone is staring at me because of my weight." Which of the following responses should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is continuing to care for the client. Exhibits The nurse is assessing the client. Which of the following findings indicate an improvement in the client's condition? Select all that apply.

Correct Answer is ["B","C","E"]

Explanation

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Correct Answer is B

Explanation

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